Medical apparatus and method for attaching a suture to a bone

Abstract

A method of forming a channel in a bone, the method comprising: providing a first bore in the bone; and forming, a second bore in the bone at a predefined angle from said first bore, using said first bore as a reference point for defining the location of the second bore in the bone, wherein the first and second bores intersect in the bone.

The invention claimed is: 
     
       1. A medical implement for attaching a suture to a bone, comprising:
 a handle having a proximal end for manual grasping and a distal end for engagement with said bone to which said suture is to be attached, said bone being pre-formed with a first bore, said handle extending axially from said proximal end to said distal end; 
 a hook extending from the distal end of the handle and configured for reception in said first bore of the bone; 
 a movable member resiliently coupled to said handle and urged in an axial direction of the handle toward the hook responsive to the resilient coupling, said movable member being movable to a retracted position with respect to the hook to facilitate reception of the hook into said first bore, and biased to an extended position with respect to the proximal end of the handle for clamping said handle to said bone with a resilient force at a predetermined angle with respect to said first bore; 
 and a manually manipulatable member coupled to said movable member for moving said movable member to said extended and retracted positions; 
 said handle being formed with a passageway extending longitudinally therethrough from its proximal end to its distal end, said passageway being configured for receiving a drill, for drilling a second bore through said bone at said predetermined angle with respect to said first bore and for passing through the passageway one end of a suture to traverse, and to extend past, said first bore such that said one end of the suture is accessible through said first bore for being pulled out therefrom, while the opposite end of the suture is accessible through said second bore for pulling out therefrom in order to attach the suture to said bone. 
 
     
     
       2. The implement according to  claim 1 , wherein said movable member is in said distal end of the handle. 
     
     
       3. The implement according to  claim 1 , wherein said hook includes a loop movable to an extended position with respect to the hook for facilitating entry of said first end of the suture through said loop into said first bore of the bone, and to a retracted position towards said hook for clamping said first end of the suture to enable pulling out said first end of the suture through said first bore of the bone;
 and wherein said handle includes a second manually manipulatable member coupled to said loop for moving the loop to its extended and retracted positions. 
 
     
     
       4. The implement according to  claim 3 , wherein said second manipulatable member includes a knob coupled to a stem slidable through a slot in said handle and coupled to said loop. 
     
     
       5. The implement according to  claim 4 , wherein said stem is coupled to said loop by a cable extending through a sleeve in said handle coupled to said hook. 
     
     
       6. The implement according to  claim 4 , wherein said knob is slidable along an axis parallel to a longitudinal axis of the handle. 
     
     
       7. The implement according to  claim 4 , wherein said knob is pivotable along a pivot axis perpendicular to a longitudinal axis of the handle. 
     
     
       8. The implement according to  claim 1 , wherein said predetermined angle is about 70°. 
     
     
       9. The implement according to  claim 1 , wherein said manually manipulatable member is a slidable member slidably received on the proximal end of said handle. 
     
     
       10. The implement according to  claim 9 , wherein said proximal end of the handle includes a threaded section, and further includes a nut threaded on said threaded section to lock said slidable member in position. 
     
     
       11. The implement according to  claim 9 , wherein said slidable member is coupled to said hook by an elongated member extending through said handle. 
     
     
       12. The implement according to  claim 11 , wherein said slidable member includes a pair of transversely-aligned finger pieces, and a central stem affixed to said elongated member and slidable within a slot formed in said handle. 
     
     
       13. The implement according to  claim 12 , wherein said elongated member is an elongated sleeve fixed to said hook. 
     
     
       14. The implement according to  claim 1 , wherein said first and second bores are linear bores. 
     
     
       15. A medical kit for attaching a suture to a bone in an arthroscopic surgical procedure, comprising:
 the medical implement according to  claim 1 ; 
 and a drill receivable within said passageway of the handle for drilling said second bore in the bone; 
 said drill including a stop engageable with said proximal end of the handle to fix a length of the second bore to extend past said first bore, to thereby permit said one end of the suture to traverse and extend past said first bore in order to facilitate its access and extraction via said first bore. 
 
     
     
       16. The kit according to  claim 15 , wherein said drill has a diameter of 2.5 mm. 
     
     
       17. The kit according to  claim 15 , wherein said kit further includes a suture loader sized and configured for reception in said passageway of the handle and for passing said suture through said second bore past said first bore in the bone. 
     
     
       18. The kit according to  claim 17 , wherein said suture loader includes a distal end formed with a slot for receiving said suture, and a proximal end formed with a handle having flat opposed sides parallel to said slot for orienting the suture loader with respect to the suture to be received within said slot. 
     
     
       19. The kit according to  claim 15 , wherein said kit further includes:
 a drill guide having a distal end engageable with said bone at the location of the first bore to be formed therein; and a proximal end opposite to said distal end; 
 and a second drill receivable within said drill guide, said second drill including a distal end formed with cutting edges to drill said first bore in the bone, and a proximal end formed with a shoulder engageable with the proximal end of the drill guide for defining a depth of the first bore to be drilled by said second drill. 
 
     
     
       20. The kit according to  claim 19 , wherein said second drill has a diameter of 2.9 mm. 
     
     
       21. The kit according to  claim 15 , wherein said kit further includes a suture hook sized and configured for reception in said first bore and for extracting said one end of the suture therethrough. 
     
     
       22. An implement according to  claim 1 , wherein the handle is elongate and wherein said hook extends from the handle in a direction of an axis of the elongate handle. 
     
     
       23. An implement according to  claim 1 , wherein said movable member is configured for clamping the passageway against the bone when the hook is inserted into the first hole. 
     
     
       24. The implement according to  claim 1 , wherein the manually manipulatable member is the only member of the implement that requires manual manipulation for both reception of the hook into said first bore and for clamping said handle to said bone. 
     
     
       25. A medical implement, comprising:
 a hook that is formed from a single piece with a bend to hook a first bore in a bone; 
 a passageway for placement at an entrance to a second bore in the bone; and 
 a grasper extending from the hook, said grasper being adapted to grasp an end of a suture inserted through the passageway and through the second bore, 
 wherein said passageway is movable by retraction or extension of a resilient member towards and away from said hook. 
 
     
     
       26. The implement according to  claim 25 , wherein said grasper is adapted to grasp a first end of said suture inserted through the passageway and through the second bore, while the second end of the suture is left outside the second bore in the bone. 
     
     
       27. The implement according to  claim 25 , wherein said grasper comprises a loop. 
     
     
       28. The implement according to  claim 25 , wherein said first and second bores are linear bores. 
     
     
       29. A medical implement according to  claim 25 , wherein the hook is formed from a first section and a second end section, the bend being between the first and second sections, and wherein the first section is substantially parallel to said passageway and the second end section is substantially perpendicular to said first section. 
     
     
       30. A medical implement according to  claim 29 , wherein the second end section is sized and shaped so that the second end section may be received in its entirety in a bore thereby causing the first section to at least partially rest on the bone. 
     
     
       31. A medical implement comprising:
 an elongate element comprising a proximal end for manual grasping and a distal end for engagement with a bone; 
 a first passageway formed in the elongate element and extending from said proximal end to said distal end of the elongate element; and 
 a hook formed in said distal end of the elongate element capable of slidably inserting into a straight bore in the bone, 
 wherein at least one of the hook and a part of the elongate element formed with the first passage way is movable by retraction or extension of a resilient member from a retracted position to an extended position along or parallel to an axis of said elongate element and wherein the hook, the part of the elongate element and the resilient member provide for clamping the bone with a resilient force, wherein the resilient member is urged in an axial direction of the elongate element toward the distal end of the elongate element responsive to the resilient member. 
 
     
     
       32. A medical implement according to  claim 31 , wherein the hook comprises a second passageway including a grasper movable to an extended position with respect to the second passageway where the grasper extends from the second passageway and to a retracted position where the grasper is entirely positioned inside the second passageway. 
     
     
       33. An implement according to  claim 32 , wherein the grasper is permanently coupled to said second passageway. 
     
     
       34. An implement according to  claim 31 , wherein said hook is formed from a first section and a second end section, and wherein the second end section is substantially perpendicular to said first section. 
     
     
       35. An implement according to  claim 34 , wherein said first section is substantially parallel to the axis of the elongate element.